My third doula client is due the end of March. Do I have the luck and privilege of supporting her in labour? No, I do not. Her baby is breech, her doctors referred to an OB, her OB has recommended against "taking the risk" of a vaginal breech birth (despite the fact that this OBs own surgical SOCIETY has revised the breech position recommendations to include shooting for a vaginal birth BECAUSE IT IS SAFER, and performing surgery if the baby shows signs of distress). Cut, cut, cut, slice, slice, slice, chop, chop, chop--are we making a salad? Oh, no. We are making holes in uteri against the recommendation of our overseeing college because we feel that surgery is safer. Do we think about this woman's future increased risk of placenta previa? Placenta accretia? Uterine rupture? Infertility? Adhesions? Infection? Hemmorhage? Ectopic pregnancy? Future cesareans? Nope. How about the baby's increased risk of transient tachypnea? Premature birth? Laceration with the surgical scalpel? Breastfeeding problems? Hospital-acquired infection? Nope. Well, maybe we do. But we're pretty confident that those things won't happen, because we see them rarely. We're pretty confident that we WILL see complications if we 'let' this woman deliver vaginally though. Because we see them rarely (actually, never, because we surgically deliver all babies who present this way!). Hey wait! That doesn't make sense!
I'm frustrated. No, the whole frickin point isn't just to avoid a cesarean, and don't worry I'm spilling it ALL HERE so that my client has no idea that I'm frustrated. My personal agenda has no business anywhere near her birth. I just get frustrated when I see evidence of very little effort to strive towards natural birth, like it doesn't really matter how a baby enters the world, just so long as it does. Of course it doesn't matter how a baby enters the world if the woman or her baby either would have died or could likely have died or suffered injury from a natural birth. OF COURSE. But when the choice is between a safe vaginal delivery and a safe cesarean, the statistics show a higher risk of complications with the cesarean. The WHO meta reviews have shown that if a region's cesarean rate is higher than 10-15%, women and babies are being harmed more than they are being helped. Why? Because those risks I listed above sometimes come true for some women. This becomes statistically significant at cesarean rates higher than 15%.
So. I want women and their care providers to choose safer options, which strive towards physiological birth. Baby out of vagina. Period. I want this because it is BETTER FOR WOMEN.
Another frustration for me is that my client's OB has not ordered an External Version. Cutting without even *trying* to rotate the baby makes me mad. I've encouraged my client more than once to ask for an EV, so I hope she remembers. And I hope he DOES ONE. And baby FLIPS. Of course I have recommended a host of other baby flippin' tricks as well, which haven't worked thus far. Flip, baby, flip! Because physiological birth is healthiest for woman and baby.